Have you had a gastric sleeve procedure? Are you concerned that the procedure may have failed or is not meeting your expectations? Gastric sleeve revision may be a procedure you are considering if you have not lost enough weight following gastric sleeve surgery, you are regaining weight, or you have suffered from medical complications due to your gastric sleeve.

What Is a Gastric Sleeve?

Gastric sleeve surgery, also known as vertical sleeve gastrectomy (VSG), is a surgical procedure performed to help bariatric patients lose weight. In a VSG, 75-80% of the stomach is removed, which leads to three key changes in your digestive physiology:

• The volume of food that your stomach can comfortably hold at one time significantly decreases due to the smaller size of your stomach.
• The secretion of ghrelin, the hunger hormone, is inhibited because it is released in the fundus of the stomach, which is removed in a sleeve gastrectomy.
• Stomach motility increases, causing food to exit the digestive tract much quicker, resulting in decreased nutrient absorption.

While some other bariatric surgeries attach the modified stomach to a different section of the small intestine, gastric sleeve surgery does not modify the small intestine. A gastric sleeve is performed via laparoscopic surgery, in which small incisions are made in the abdomen and a surgeon is able to operate with the use of a small camera through the incision sites.

Gastric sleeve surgery is the most common bariatric procedure performed in the United States.

What Are the Benefits of a Gastric Sleeve Besides Weight Loss?

A gastric sleeve can improve a person’s overall quality of life by removing excess weight within the first year following surgery. By removing this excess weight, health conditions related to obesity can be in remission or improved.

These conditions include hypertension, diabetes mellitus type II, fatty liver disease, hyperlipidemia, joint pain, and sleep apnea. Furthermore, with the inhibition of ghrelin, patients can have greater control over their detrimental eating patterns.

How Much Weight Loss Occurs on Average After Gastric Sleeve Surgery?

Most people lose between 50 and 90 pounds following the procedure, or 60-70% of their excess weight. Within the first two weeks, most people will lose around one pound a day, resulting in a 10-20 pound weight loss in the early post-operative period. Weight loss continues over the first year, and most people find they reach their lowest weight within 12-24 months after surgery.

What Is Gastric Sleeve Revision?

Revision surgery after gastric sleeve is performed on patients who have experienced complications or failure of a gastric sleeve. People consider vertical sleeve gastrectomy reversal if they are not experiencing enough weight loss, are regaining weight, or have developed complications from gastric sleeve surgery such as GERD.

The most common cause of weight gain following a sleeve gastrectomy is lack of lifestyle changes.

What Are My Gastric Sleeve Reversal Options?

There are three main procedures for revising a gastric sleeve:

• Conversion to biliopancreatic diversion with duodenal switch
• Conversion to gastric bypass
• Re-sleeve gastrectomy

Biliopancreatic diversion with duodenal switch is a complex weight-loss procedure that reduces your ability to absorb vitamins, nutrients, and calories. In this procedure a gastric sleeve is performed to reduce the volume of food that can be held by the stomach. Then the stomach is detached from the upper part of the small intestine and re-attached at the lower end of the small intestine to reduce the calories and nutrients that your body can absorb.

The final component to this procedure is to re-route the flow of bile and digestive juices so that there is a further decrease in caloric absorption. While this procedure can potentially help you lose more weight than gastric bypass or sleeve gastrectomy, this procedure does put a patient at higher risk for nutritional deficiencies — some of which can be life-threatening if untreated.

Gastric bypass surgery reduces the size of the stomach to a walnut-size pouch to decrease the amount of food that can be digested at one time. This small pouch is then attached to the lower end of the small intestine so less nutrients can be absorbed.

The duodenum, the first part of the small intestine, is then reattached to the lower end of the small intestine so that digestive juices and enzymes can eventually mix with food.

Re-sleeve gastrectomy is typically performed on a patient who has already undergone a sleeve gastrectomy. It is typically performed if the modified stomach still holds too much food at one time or if the remaining stomach has become hyper-dilated or enlarged.

If a patient is still able to consume a larger volume of food and has not developed GERD, they may be a candidate for a repeat sleeve gastrectomy to further decrease the stomach size.

What Are Indications to Have a Gastric Sleeve Revised?

Failure to lose sufficient weight, regaining weight post-operatively, and medical complications are the three main reasons why people may pursue gastric sleeve revision. Some patients find that the stomach can stretch out after gastric sleeve surgery, allowing for an increase in food intake and consequent weight gain.

What Are Possible Risks of Gastric Sleeve Reversal?

Along with any surgery, gastric sleeve reversal can lead to short term and long term risks. Short term risks in the post-operative period include:

• Excessive bleeding
• Blood clots
• Infection
• Adverse reactions to anesthesia
• Leaks from incision in the stomach
• Breathing complications

Long term risks of gastric sleeve reversal include:

• GERD
• Malnutrition
• Vomiting
• Gastrointestinal obstruction
• Hernias
• Hypoglycemia
• Failure of gastric sleeve reversal

How Much Does Gastric Sleeve Revision Cost?

If you have insurance and it covers bariatric surgery, your insurance company may cover part, or all, of your procedure costs if you meet the same body mass index (BMI) requirements as your initial gastric sleeve. These criteria usually include a BMI of 40 or greater, or a BMI of 35 or greater with health conditions. Insurance may also cover your procedure if you have side effects that make the procedure necessary such as GERD.

If you have insurance, talk to you insurance carrier to see what procedures are covered and what your out-of-pocket deductible will cost. The average cost of gastric sleeve surgery is $19,190 in the United States. After meeting your deductible, your insurance may cover around 80% of the procedure, which would cost you around $3,500 out-of-pocket. Each insurance company has its own unique template for coverage, so contact your insurance carrier to find specific costs for you.

What Can I Try Before Pursuing Gastric Sleeve Revision?

The number one reason gastric sleeves fail is because patients do not adhere to the lifestyle changes necessary to ensure weight loss. Patients must follow a strict diet after surgery and must be cautious about the volume and type of food and liquid consumed.

Before considering VSG revision, talk to your physician and their dietician about getting back on track with your diet and exercise regime. Re-visit what foods you should eat and avoid, and understand how to eat, such as eating only three small meals a day. Consider other lifestyle habits such as exercise, mental and emotional health, and alcohol consumption that may play a role in weight gain following VSG.

As with any surgical procedure, there are risks, so it is imperative to evaluate your current habits and make changes as needed. Do not hesitate to reach out to your support team, which may include your physician, dietician, personal trainer, psychologist, and a local support group.

I Think I May Need a Gastric Sleeve Reversal: Where Do I Start?

Schedule an appointment with your physician to discuss your concerns and options if you find you have gained weight, you have not been able to lose enough weight, or you have concerning symptoms since your initial gastric sleeve procedure.